hey everyone nurse Mike here from simple nursing.com today we're breaking down renal failure chronic kidney disease and endstage renal disease into simple high yield concepts tailored for your nursing exams so get ready for visual cues and memory tricks to make it all stick and if you're a simple nursing member be sure to grab these three study guides to follow along all right let's get started now for renal failure we're covering acute versus chronic so for chronic kidney failure also called chronic kidney disease or just CKD this is long-term chronic damage to the kidneys we're talking over years and years of destruction typically resulting in permanent damage and acute kidney failure also called acute kidney injury is that sudden short-term loss of kidney function but if not stopped or reversed it can lead to chronic renal failure so a Kaplan question asks about acute kidney injury what is the correct understanding and the answer is sudden loss of kidney function due to loss of renal system circulation or glomeular or tubular damage so what's really going on in the body for pathophysiology and causes let's cover the acute kidney failure first in acute kidney failure it can result from three types we have prenal that decreased blood flow to the kidney so the memory trick we use is think of decreasing of prefusion with pre-renal and then next is intrarrenal that damage inside the renal think in the renal for intrarrenal and if the cause is after the renal that's postrenal so just think post for past renal now let's dig into the specifics here so for prenal just think of that decreased profusion for pre-renal oxygen-rich blood flow can't get to the kidneys this decreased blood flow means decreased oxygen so remember oxygen is the money of the body no money no honey no oxygen and the body goes broke and dies kind of like the kidney is suffocating to death now this is typically caused by obstruction or vessel occlusion where we have a blockage of blood flow which blocks oxygen now this is typically from an emblei or blood clot or even a tumor that blocks perfusion into the kidneys another cause is from low blood pressure that low perfusion with pre-renal like patients with shock hypoalmia from that major blood loss or volume loss resulting in dehydration which results in decreased MAP that mean arterial pressure fancy words for low blood pressure meaning low perfusion less than 65 map for mean arterial pressure lastly low cardiac output we get low perfusion so just think low cardiac output means low oxygen put out of the heart resulting in low perfusion to the kidneys typically from when the heart can't pump correctly which decreases blood being pumped out of the heart so we see this with ECG dysriythmias with those funky beats and even clients in heart failure which is a little bit tricky so listen close even though we may have high blood pressure with heart failure clients the big problem is low cardiac output we get low volume of oxygen rich blood out of the heart this results in less perfusion and less oxygen to the kidneys next we have intrarrenal that direct damage inside the kidney itself again think intrarenal for inside the renal now this is far more serious because it's more intense with intrarenal now it's also referred to as ATN acute tubular necrosis so just think ATN requires immediate attention now typically it's caused from infections resulting from glomeular nephritis or even autoimmune diseases like lupas where the body attacks itself resulting in nefertic syndrome which we cover both in a separate video but really the most tested top two causes for exams write these down is CT contrast die like with a hard cath so just remember contrast kills the kidneys and even antibiotics ending in myin like venkcomyosin and genttomyosin so just think it's a sin to give a myiain since it's so damaging to the kidneys lastly untreated infections and even long-term use of NSAIDs like neproxin ibuprofen and even couttorillac can cause damage to the kidneys it's kind of like overloading two delicate washing machines with thick cement we literally clog the kidneys here with these medications and in results the creatinine lab value shoots up sky high so the key number to know is creatinine over 1.3 is bad kitney and the memory trick we use just think of the three C's creatinine is the most critical lab value since it shows clogging of the kidneys and last but not least we have post-renal just think past the renals there's a renal blockage after the kidneys which basically blocks the outflow of urine so urine can't get out of the kidney itself causing a lot of pressure pain and strain on the renals like with clients with renal calculi aka those kidney stones or even a tumor or even BPH that benign prostatic hyperplasia we see a big swollen prostate in our older men populations so just think the memory trick BPH as a big prostate that holds back urine and now we have an outflow problem as far as assessment findings these are pretty simple so remember from our anatomy video what are the three waste products that the kidneys filter well remember we use our acronym Hook h U C since the kidneys sort of kind of look like a pirate hook h is for hydrogen ions which are very acidic u is for ura and C is for creatinine so the key numbers to know is creatinine over 1.3 is bad kidney bu over 20 is very bad urine output 30 mls per hour or less means the kidneys are in distress and metabolic acidosis is pH below 7.35 this is typically due to the retention of all those hydrogen ions which pushes the body into an acidotic state now Kaplan had a question about this asking what is the best indicator for good renal function and the answer is 1,500 ml of urine in 24 hours remember here urine output 30 mls per hour or less means the kidneys are in distress so 1500 is very very good in 24 hours now this next part is not a big focus on the enclelex but it may show up on your nurse and exams the four phases of acute renal failure so number one is the onset of injury known as initiation which is not typically tested step number two is the oliguric phase now this one is key to know so just think of the O's in oliguric as O for low urine output less than 400 mls in 24 hours remember urine output 30 mls per hour or less means the kidneys are in distress so 400 mls in 24 hours wow that is really really low and just think very sticky thick urine we get specific gravity that is high so the memory trick we use is if urine is dry then the specific gravity is high now the third phase is the diarice phase also called the polyuric phase so just think diares D for draining urine a dramatically high urine output like 3 to 6 L per day the kidneys are basically trying to flush out the problem so very low liquidy urine with a specific gravity that is low the last phase is the recovery phase so just think R for really slow recovery since it can take up to one year to fully recover and the key numbers are returning to normal during this phase now a Hessie scenario asked oliguric phase of acute renal failure some key findings and the answer is anorexia nausea vomiting and key term here decreased urinary output so just think low urinary output with oliguric phase now the treatments are pretty simple here the main goal is to prevent major kidney damage and we do this by flushing the kidneys with a fluid bolus or diuretics we're basically trying to push the kidneys from oliguric phase into the diaresis phase so Hessie mentions a patient reports a loss of appetite severe headache and lethargy and dry mucous membranes with key terms here urinary output 300 mls in 24 hours that is really really low elevated blood ura nitrogen that bun and serum creatinine so the answer is to treat with ferrosomide now if you didn't know ferosomide is a diuretic that pushes the kidneys into the diaresis phase so just think ferosemide ends in ey so the body is dried from diarasing all that fluid from the body and into the body be sure to have this study guide handy for this section so you can follow the content and make this knowledge actually stick now switching gears to chronic kidney disease this is a gradual loss of kidney function going in stages kind of like shirt sizes going from extra small to extra extra large problems now we have five stages of CKD based on the GFR the glomemeular filtration rate stating how much blood can be washed by the kidneys in each minute specifically inside these little washing machine bubbles called the glomemeulus now key term write this down over 90 mls per minute is considered normal as you can see here as the GFR gets less and less this means the kidneys are in distress this means that less and less blood is being washed resulting in the blood filling up with waste and excess fluid and way too many electrolytes now this is no laughing matter because the kidneys are in distress here but here's the key point the five stages are not really tested on the enclelex but it can be on your nursing exams so really focus on the stages four and five here since it means that the end stage of this renal disease is getting really bad here the kidneys are failing basically failing to filter the blood with this low glomemeular filtration rate that low GFR so stage four we have 29 to 15 GFR and stage five this is the worst 15 or less GFR this is considered endstage renal disease now the kidneys are basically dead in this stage there's no way to bring the kidneys back to life so we typically have to do a kidney transplant and put our patients on dialysis in the meantime now dialysis is that machine version of the kidneys that are used to wash the blood which we cover in a separate video now let's cover the causes of chronic renal failure the first cause is older age geriatrics typically lose 10% of renal function each decade technically older age just leads to physiological decrease of renal function and not renal failure specifically but you get the idea here now the most tested causes for chronic renal failure is from long-term years and years of chronic damage so please write this down you have to know that uncontrolled diabetes from uncontrolled high sugar is a major cause as well as uncontrolled hypertension from that uncontrolled high blood pressure and even unchecked autoimmune diseases where the body attacks the kidney so to help you paint the picture better here just think of a patient with diabetes who has uncontrolled hypoglycemia for years just think of all this thick syrupy blood like sugary maple syrup being poured into the body it's like mud inside the delicate kidneys specifically inside the delicate glomeuli what do you think it's going to do to the kidneys here do you think it's going to destroy them well yes it's like thick cement being poured into a delicate washing machine which eventually kills the kidneys resulting in renal failure or what about a patient with years and years of uncontrolled high blood pressure think about all that pressure coming from the heart and just pounding against these poor little blood vessels inside the kidneys eventually scarring and hardening those leading to less blood flow and resulting in kidney failure that's why it's so important to educate your clients to control their sugar and high blood pressure lastly other main causes include infection causing glomemeular nephritis acute renal failure that worsens and progresses into chronic kidney disease and even polycystic kidney disease where cysts develop inside the kidneys themselves hessie mentioned this asking about polycystic kidney disease indicating that the client is at risk for endstage renal disease now whatever the cause the diagnostics are typically the same here so creatinine our number one kidney lab remember over 1.3 means bad kidney again think of the C's c for creatinine C for critical lab value so a key term to know is creatinine clearance test this measures how much creatinine waste is being cleared from the body and into the body specifically how well the glomemeular filtration rate is working to wash the waste out of the blood the test requires both a urine specimen and a blood specimen in 24 hours so the key points to write down and to know for your exams is 24-hour collection of all urine in a container and we put it on ice to keep it cold and another key point is you discard the first urine specimen when the test begins write that down it's always a test question now don't let the enclelex trick you here we do not need a midstream sample or a sterile container that's mostly used for UTI when you're checking for bacteria or infection now a Hessie question asks "What's the correct understanding of creatinine clearance test?" And the answer is to save all the urine samples in a container for a designated period after discarding the first urine so you kind of see how those two key points are tied in there unlock thousands of questions and exit prep lectures in our membership your shortcut to boosting your path to nursing success now switching gears to signs and symptoms just think about the patho here you have broken washer machines right so we can't wash the blood from waste or excess electrolytes and even fluid but most importantly we can't get fluid out of the body and into the body this lack of urine output is called ooligura so remember the O's for low urine output in oligura very very low urinary output like less than 400 mls per day so Kaplan mentions a patient with chronic kidney disease oligura is expected for low urinary output another highly tested area is the critical complications so just think all this excess fluid and electrolytes are trapped inside the body and can cause dangerously high blood pressure from all that fluid volume overload now dangerously high blood pressure can lead to strokes heart attacks and even further kidney damage from that high tension on all the organs so the first priority is to monitor for hypertensive crisis now the priority key signs to write down huge enclelex tip here so number one is headache number two is nausea and vomiting and number three a really big one here is change in mental status now these three are always priority requiring immediate assessment write these down we saw them on various question banks for key term hypertension crisis you must report these key signs to the HCP provider immediately now clients can also get multiple other signs revolving around fluid volume overload including crackles in the lungs those wet fluid fil lungs JVD that jugular vein distension as well as bounding pulses from that fluid volume excess but these do not take priority over hypertension crisis so you must know that for your exams and ultimately the enclelex another sign is anemia those low RBC's red blood cells Since the kidneys release irithropoetin which is that hormone that stimulates bone marrow to produce red blood cells which helps carry oxygen around the body but typically that's expected to know and not tested now what is tested is excess waste and electrolytes in the blood due to these broken washing machines so for waste we have hydrogen ions just think acid when you see hydrogen ions we get metabolic acidosis with a pH below key number here 7.35 due to the retention of all those hydrogen ions and we also see ura since it can't get out of the body and into the body which eventually develops into uremic frost those crystallized ura deposits on the skin basically white frost causing paritis that itchy skin but again these are normal and to be expected and not priority over hypertension crisis remember those headaches nausea and vomiting and change in mental status are all priority here so don't get it twisted now for the electrolyte values these are always exam favorites so be sure to write these down sodium is high over 145 just think high sodium we get high swelling which can lead to hypertension crisis phosphorus is high over 4.5 which leads to decreases in our calcium leading to osteoporosis those porous weak bones making a huge risk for fractures now the big critical one here is potassium that is high over 5.0 now this is the most important number one electrolyte on the enclelex and nursing exams since it pumps the heart so the memory trick we use is the three Ps just think P for potassium is P priority since it pumps the heart muscles so with high potassium over 5.0 know we get high pumps of the heart resulting in peak T- waves and ST elevations from high pumps so key terms to know peak T- waves happens when potassium is 6 to 7 microe equivalents per liter st elevation happens when potassium is between 7 to 8 and wide curis complexes is a late sign over eight basically the heart is cramping up from too much potassium too much high pumps makes a very tight heart that is just basically cramping all up you have to think that the heart's a muscle right so do you really think the heart can pump normal if this muscle is cramping well no so this leads to brada cardia that low heart rate since the heart is too tight and can't beat correctly and which ultimately results in weakness fatigue and lethargy from less cardiac output meaning less oxygen out of the heart into the body and then finally leading to deadly ventricular dysriythmias like VTAC and VIB that ventricular tacocardia and ventricular fibrillation if not treated immediately this will cause death by cardiac arrest basically that stopped heart so that's why potassium is priority on the enlex and nursing exams since it pumps those heart muscles now Kaplan had a scenario asking a client with kidney disease is very weak lethargic and bradaartic asking for a suspected finding for this patient so the key term here is kidney disease that is weak lethargic and brada cardartic that low heart rate so you have to automatically prioritize and think about potassium here so potassium 8.5 is the lab value to be suspected now in terms of treatments the long-term solution is to wash the blood with dialysis but this can take some time to set up so the immediate priority solution and treatment is to lower the potassium and protect the heart from deadly dysriythmias we do this with drugs in a very specific order so write this down for priority treatment number one is IV calcium gluconate for the key term write this down disriythmias just think gluconates helps to glue down those crazy heart muscles preventing deadly disriythmias like wide QRS complexes which will eventually progress into deadly vtac and vib we must glue down those heart muscles with calcium gluconate now if the key term of dysriythmias is not involved in the question then we progress to number two which is IV 50% dextrose and regular insulin this helps to lower the potassium so just think insulin puts sugar and potassium into the cell out of the blood and into the cell which lowers blood serum and potassium most effective way to lower blood potassium very quickly but insulin also lowers blood glucose too basically that blood sugar so that's why we also give dextrose to help prevent that low blood sugar that hypoglycemia now don't let the anklelex trick you here what if the key term dysriythmias is not in the question well then we progress to option two which is just to give the ivy dextrose and insulin first to lower that high potassium and lastly three and four we can also give kxolate that polyyrene sulfonate as well as dialysis but again these typically take longer to lower potassium so that's why we put them last here on the list because they take a longer time let's review some of the most commonly missed enclelex questions pulled from our simple nursing question bank written by actual enclelex writers so question number one a patient with chronic kidney disease missed three diialysis sessions uh oh with key terms here potassium level of 8.1 wide QRS complexes a heart rate of 58 and lethargy which order or prescription should the nurse implement first so the key term here is high potassium with wide QRS complexes that key term indicates dysriythmias so just think you have to give calcium gluconate first to glue down those crazy heart muscles and prevent the progression into those deadly heart disriythmias so option number four IV calcium gluconate because the key term was about disriythmias and high potassium now question number two endstage renal disease with a potassium of 7.2 2 a bun of 35 creatinine of 38 and urinary output of 300 mls in 24 hours which order is priority so this question says high potassium right but nothing about ECG dysriythmias or basically heart disriythmias so we need to lower that potassium first with insulin which puts sugar and potassium into the cell so option number one IV regular insulin and 50% dextrose yes we give this first not loop diuretics and not dialysis this is used later and definitely not option number four the vacation time even though it's pretty tempting now as far as nursing interventions generally we check daily weights at the same time every single day so the key number to know is 1 kilg equals 1 liter of fluid retained so we must report any type of fluid retention to the HCP immediately because this can lead to fluid volume overload and hypertension crisis now we also avoid the top drugs that can cause kidney injury like NSAIDs as mentioned before so just think N in NSAIDs is N for not good for the entire body we also avoid milk of magnesia that antia acid as well as antibiotics those venkcomyosin and genttoyosin remember it's a sin to give amayia sin since it kills the kidneys as well as CT contrast dye remember contrast kills those kidneys just think of that contrast dye like thick cement in those delicate washer machines of the kidneys now as far as procedures as mentioned before hemmoiialysis which is is the machine version of the kidney is used to wash the blood but only used for a number of years until a kidney transplant is available now we cover both of these in their own separate videos thanks for watching did you know you can unlock beautifully handcrafted study guides packed with key points and memory tricks from all our videos plus you'll get access to over 1,200 exclusive videos not on YouTube all neatly organized by nursing school topic to make that complex nursing knowledge actually stick you'll also gain thousands of practice questions written by current professors and actual ENCLEX writers so for access to all this and more click right up here or visit simplening.com and don't forget to subscribe to our YouTube channel happy studying and we'll see you in the next videos